NHS failing child sexual abuse victims in adulthood, say psychiatrists

The Royal College of Psychiatrists is issuing a public apology for what it says is decades of mismanagement and misdiagnosis in the UK.

For some, it has worsened their traumas, it said.

The college said mental health staff have been too focussed on treating symptoms rather than exploring how past traumatic experiences can still affect patients.

Support is improving, it said, but there must be better training and more investment - something NHS bosses have said is being introduced.

The apology has been included in a report, external by the college and given to the BBC.

Immediate past president of the college, Dr Lade Smith, said she was "sorry" that, too often, victims have suffered "avoidable harm when seeking help".

The report details how treatment has sometimes been inappropriate, while people have been re-traumatised by the experience of repeated assessments and history-taking and not always being believed.

Dr Smith told the BBC it was clear people were not getting the support they needed, and that this was not just a failing of psychiatrists, but the whole mental health system.

"Services are so fragmented. The system is set up to provide short, discrete episodes of care. Psychiatrists do not get the time to build up a relationship with patients so they can be properly supported.

"They are lucky if they get eight sessions of therapy, when it could take eight sessions for a person just to disclose the abuse.

"And these are just the people who get support – many don't even get seen by mental health services because services are so stretched," she said.

 
Badly let down

Estimates suggest nearly one in 10 adults in England and Wales were sexually abused in childhood.

Such trauma increases the risk of mental health problems, including alcohol and drug misuse, eating disorders, self-harm, complex PTSD, anxiety and depression.

Many struggle to talk about the abuse. Around two-thirds of those abused as children have not disclosed it to services by the time they reach adulthood.

One in five never disclose, and many of those that do take decades to speak out.

Caroline Thompson, 65, is someone who feels let down by the NHS.

She was psychologically and sexually abused when she was a child.

She went on to raise a family and have a successful career as a specialist ear, nose and throat doctor.

It was not until she started experiencing terrifying nightmares, aged 55, that left her unable to function due to mental exhaustion and lack of sleep, that she realised she needed help and was referred to mental health services.

The psychiatrist she saw said her symptoms were unlikely to be due to the abuse because of the delay in presentation and given she had been able to have a family and successful career. She was diagnosed with anxiety and given anti-psychotic drugs.

"I had therapy for about a year and was then discharged. At that point I still didn't understand what was happening to me and I still couldn't function due to the nightmares and side-effects of the drugs. I had to give up the job I loved."

Caroline then got private therapy with a therapist who specialised in childhood trauma and gradually began to get better over the next few years.

She says: "It was astonishing to me that it was not understood that traumatic memories are buried in order for you to survive, and that those memories can surface years later. So any delay in presenting is quite normal."

Meaningful change

The apology comes after the college set up a working group of experts, doctors and abuse survivors, including Caroline and chaired by leading consultant psychiatrists Jo Stubley and Maria Podlejska-Eyres, to review NHS care.

The group was set up after mental health services have seen a rise in people coming forward seeking help in the last decade or so, following high-profile abuse scandals involving schools, children's homes and religious institutions, as well as the Jimmy Savile crimes.

The college is calling for a number of changes. It is promising to develop specialist training materials for psychiatrists, but wants mandatory training for all mental health staff on the importance of trauma-informed care for survivors of child sexual abuse.

And it has recommended national guidance be published on how to recognise and respond to disclosures of historic child sexual abuse, as well as an overhaul of services so those needing help can get the long-term support they need.

Gabrielle Shaw, chief executive of the National Association for People Abused in Childhood, said this was a "significant and welcome" apology, but it must lead to "meaningful change".

"For too many adult survivors, mental health services have not felt like a route to safety or recovery."

A spokesman for NHS England said specialist services were available, highlighting how victims could access support 24 hours a day, seven days a week through sexual assault referral centres and counselling services with information about them available on the NHS website, external.

"People who have suffered historic child sexual abuse may not have spoken about it for years, so it's vital they know they can access specialist, trauma-informed support through the NHS," he added.

He also said steps were being taken to better support children and young people with additional training being provided to mental health support teams in schools and colleges.

If you've been affected by the issues in this story, you can find information, advice and support from the BBC's Action Line. Anyone feeling emotionally distressed or suicidal can call Samaritans for free on 116 123 or visit samaritans.org in the UK.

Source: NHS failing child sexual abuse victims in adulthood, say psychiatrists | BBC News